Amputation is the removal of limbs that have lost their viability, endanger their health and lost their physiological functions. Trauma and infection are the most common causes of amputation. Amputation causes the limb to lose its normal shape, which is a serious trauma and causes great harm to the patient's body and mind. Therefore, the postoperative rehabilitation of amputation is particularly important. Through effective rehabilitation training, it is beneficial to help patients overcome various physical and mental obstacles, improve the self-confidence of amputee patients, help patients to install prosthesis smoothly, so that patients can take care of themselves in daily life and return to society as soon as possible.

Treatment of complications

1. Stump hematoma and hemorrhage

It is mainly caused by incomplete hemostasis, ligation line of broken vascular end or thrombus shedding during operation. Postoperative observation should be strictly observed for hematoma and bleeding at the stump of the affected limb, pay attention to keeping the drainage unobstructed, prevent the distortion and compression of the drainage tube, and observe the volume and nature of the drainage fluid. Timely cold compress on the stump can also reduce bleeding from the wound.

2. Stump infection

As a result of severe injury trauma of limbs, postoperative wounds can sometimes appear different degrees of infection, manifested as high fever, chills, and necrosis of the surrounding skin and tissues. Infection not only causes wound hard to be healing, but also can lead to systemic poisoning and induce multiple organ failure. Large area wound infection should do bacterial culture and drug sensitivity test, but also often check the wound, dressing change. Those who do not heal over a long period of time should be cleared and anti-infection treatment.

3.Phantom limb pain

Amputees often feel that the amputated limb is still present and has pain, which is usually persistent and more severe at night. Analgesic drugs are not recommended for patients with phantom limb pain. The occurrence of phantom limb pain can be overcome by patient counseling of medical staff, so that patients gradually accept the fact of limb loss. Alternatively, local hot compress, physiotherapy and acupuncture and moxibustion can be adopted for analgesia.

4. Joint contracture

Postoperative placement of the affected limb for a long time without early exercise can lead to joint contracture. Therefore, after wound stitches are removed, active movement, resistance movement, amputation side joint activity exercise should be carried out in time, and massage of the residual limb.

Rehabilitation training

1. Residual muscle strength training

The muscle strength training of stump is particularly important for the skilled control of prosthesis in the future, so the muscle strength training should be increased as soon as possible after amputation. Exercises to strengthen the muscles of the stump can be carried out gradually one week after surgery.

Training method: fixed in plaster or elastic bandage, take the correct position of the stump muscle isometric contraction movement. Amputation of the upper arm and forearm completed flexion, extension, abduction, adduction direction of full muscle contraction; The quadriceps femoris and gluteus maximus muscle contraction and hip extension and adduction were completed respectively. In principle, the training of subknee amputation is the same as that of subknee amputation. Subknee amputation mainly focuses on the training of quadriceps femoris and the prevention of knee deformity. Active or passive exercises of knee joint can be done to strengthen knee extension training and unarmed resistance muscle strength training of knee extension. Gradually increase the amount of training and muscle resistance training after the wound has healed.

2. Residual joint activity training

All aspects of residual joint movement should be carried out as soon as possible after operation. The principle guiding joint movement is from passive activity to active auxiliary activity and then to active activity.

Training methods: 24 hours after the operation, the passive range was as close to the normal maximum joint axial movement as possible without causing unbearable pain, and the speed should be slow and gentle; After the relief of limb pain, the patient gradually transitioned to active auxiliary exercise. Finally, the patient carried out active training 2~3 times a day, 15~20 minutes each time.

3. Standing balance training and walking training

Standing balance training and walking training are also needed after lower limb amputation. Client is protected by a walking aid while performing standing and balancing exercises on a mat. This can be done by having client pass objects or by pushing client from side to side in order to establish balance and stability on one foot. Use axillary cane for walking training, in addition to walking on the ground, but also train up and down steps, change direction and flexibility, to train how to stand up after falling.

4. Assembly and training of artificial limbs

The main function of upper limb and lower limb prosthesis is very different, the upper limb is mainly flexible, the lower limb is mainly weight-bearing, so the choice of prosthesis should follow the principle of function. Specific adaptive function exercise mainly includes standing position balance exercise, application exercise, flat function exercise, steep slope function exercise, stair climbing function exercise, cycling function exercise, complex terrain function exercise and so on.

The postoperative rehabilitation of amputation patients should not only pay attention to the functional rehabilitation of the patient's body, but also pay attention to the psychological counseling of the patient, help the patient to overcome the psychological pressure after the trauma in time, and actively put into the postoperative rehabilitation training.